Nursing Role for Medication Stewardship Within Long-Term Care Facilities

Abstract

Long-term care facilities (LTCFs) provide rehabilitative, restorative, and/or ongoing skilled care to residents requesting assistance with activities of daily living over extended periods of time. The residents within LTCFs are often susceptible to infection and vulnerable to different diseases, which arise as exposure to high medication consumption increases (Tolson et al., 2013). Residents who live with multiple medications both prescribed and administered has been labelled polypharmacy. In a systematic review defining polypharmacy, Masnoon, Shakib, Kalisch-Ellett, and Caughey (2017) reported that the operational definition of polypharmacy includes "five or more medications prescribed/administered daily with a range include from two or more right up to 11 or more medications" (p. 2). In the literature, various factors have been reported that either enhance or impede achieving rational utilization of antimicrobial medications. For example, Van Buul et al. (2014) reported six categories of factors influencing antibiotic prescribing patterns, which include "clinical situation, advance care plans, diagnostic resources, physicians' perceived risks, influence of others, and influence of environment" (p. 1). In a retrospective audit, 519 records of residents within a LTCF for a 6-month time period of time appropriate antibiotic prescribing for urinary tract infections (UTIs) were compared to published criteria. When audit results were compared with published McGeer criteria "85% of patients did not meet criteria, yet antibiotic treatment was initiated in 41% of the cases" (Rotjanapan, Dosa, & Thomas, 2011 p. 438). The updated McGreer criteria serve as a standard for antimicrobial prescribing and focus on the following constitutional criteria for residents in LTCFs: fever, leukocytosis, acute change in mental status from baseline, and acute functional decline. Also outlined in McGreer criteria are three important conditions that provide specificity for LTCF residents to meet when reviewing constitutional criteria: 826310N SQXXX10.

The work status of nurses in long‐term care institutions in elderly care: A qualitative descriptive study

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Differences in and Factors Related to Willingness to Provide Care to Patients with Suspected or Confirmed COVID-19 in Long-Term Care Facilities

“…In addition, senior nurses tend to have more knowledge and expertise and are therefore better equipped to deal with difficult situations and less prone to burnout [ 22 ]. The nursing role for care stewardship within LTCF is crucial, and the nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in LTCF [ 23 ].…”

Ushering in a New Era for King’s Conceptual System and Theory of Goal Attainment

“…Information entered electronically into an electronic health record can be used by nurses and healthcare providers to effectively implement healthcare transactions and reach healthcare goals (Carroll, 2018). Chaaban et al (2019) discussed the leadership role of the nurse in using electronic health record data to foster antimicrobial and medication management in nursing homes. Stalians (2018) designed a quality improvement project tool to facilitate documentation on patient self-management of diabetes.…”